Although commonly found on echocardiograms, persistent Eustachian valves rarely result in clinical symptoms in newborns and infants without other significant structural heart disease. Previous reports have suggested that such patients require surgical treatment. The goal of this study is to delineate better the clinical course in infants presenting with symptoms that are a result of persistent Eustachian valves. A review of all patients with symptoms attributed to persistent Eustachian valves over a 10-year period at Riley Hospital for Children showed 3 of 4 patients improved, with eventual resolution of symptoms, with conservative management alone. This suggests that, contrary to previous reports, clinical observation may be warranted in many of these infants.